POLST (Physician Orders for Life-Sustaining Treatment)

POLST, or Physician Orders for Life-Sustaining Treatment, is an end-of-life planning tool that represents your instructions for medical treatment actions specific to different health-related emergencies or conditions. The instructions derive from your conversations with your healthcare team and are subsequently placed in your medical chart. POLST orders aren’t limited to those restricting or eliminating treatment, but spell out treatment levels you desire. The POLST form is signed by the physician or other treatment provider in some healthcare systems.

Documents similar to POLST include medical orders on life-sustaining treatment (MOLST), medical orders on scope of treatment (MOST), or physician’s orders on scope of treatment (POST).

POLST guidelines don’t have to be instituted at the state level through legislation; a hospital or medical group can adopt them as a medical standard of care.

The first POLST program was developed in Oregon in 1991 to create a standardized, easily recognizable, portable document which is designed to be transferable and actionable throughout the entire medical community. In Oregon, POLST forms are now accepted medical standard of care. Other states have replicated Oregon’s model and many others are currently considering establishing their own programs. As other states and hospitals adopted the model, they’ve supplemented the original work in Oregon.

Efficacy of POLST

Medical researchers have explored the efficacy of POLST as compared to other traditional communication tools. In a 2010 article published in the Journal of the American Geriatrics Society, researchers found that among nursing home residents, those with POLST forms were more likely to have their treatment desires documented as medical orders than those without POLST forms. Additionally, the existence of a POLST order curtailing treatment was associated with a decreased use of life-sustaining measures. These findings strongly support the use of a POLST program to document and implement patient wishes at end of life.

Many healthcare systems have adopted POLST programs

  1. to facilitate communication between you, the terminally ill patient, and your healthcare team about your end-of-life care wishes;
  2. to convert the wishes into medical orders; and
  3. to use a uniform form which can be transferred from one healthcare setting to another, including your home.

POLST vs. Advance Directive

POLST is an innovative approach to ascertaining and communicating healthcare wishes, but it isn’t meant to replace traditional end-of-life care communication tools like advance directives or “no code” or DNR (Do Not Resuscitate) statuses. Instead, it augments and supports other communication tools.

Whereas advance directives identify a surrogate decision-maker and provide guidelines and values underlying a patient’s wishes, POLST forms turn those wishes into medical actions ordered by a physician. The two are complementary in every sense.

Timing

When you fill out an advanced directive, you are considering end-of-life choices regarding a myriad of future treatments. You can fill out an advance directive at any time independent of your current state of health. A POLST form is intended to be used only if you are are seriously ill and are considering specific options regarding life support. A POLST form is started with a conversation between patient and physician.

Scope

An advance directive should have a clear statement of general preferences while the POLST form is selecting from a set of choices. An advance directive generally requires some interpretation of preferences but a POLST form is intended to be an actionable order requiring no interpretation if or when the existent circumstances require it.

The POLST form was created to remedy some of the disadvantages of the advance directives. Advance directives do a good job of getting a general sense of what you would want in various end-of-life scenarios but often aren’t specific enough. They require a treating physician to translate intentions into orders. If the language of the advance directive is too ambiguous, your loved ones are still in the position of “deciding in the dark” what you really wanted. POLST forms also evolve with life sustaining technologies ensuring the patient is up-to-date on exactly what life support choices are being employed.

Possession

One advantage of advance directives is they can be done without the help of a lawyer or physician and they’re still able to be used to guide patient care. You can download an advance directive online and fill it out in a matter of hours. The disadvantage is that the paperwork is with you when it should be shared with the medical professionals. POLST forms are available at doctors’ offices, completed with the help of a physician, and are created with the intent of going into the patient’s chart. They’re standardized and easily recognizable and designed to be transferable throughout different medical facilities.

Advance directives should be considered general documentation of end-of-life care wishes while POLST orders are specific instances of physician’s orders. Everyone should have an advance directive written out—no matter how young or old or sick or healthy—they’re a “just in case” coverage of intentions. If you are in a position where you have a prognosis of a year or less to live, having a POLST form is recommended.

Advance Directive First, POLST Second

POLST orders should be considered a second step to advance directives. POLST forms are a way to take your wishes from your advance directive and set them down in an unambiguous and concrete manner which is easily understood and applicable when needed. Research has shown the use of POLST forms results in higher levels of compliance from medical professionals. From physicians to EMTs to hospice care workers, most healthcare professionals find more accuracy of end-of-life preferences when you have a completed POLST order. And you are more likely to receive the end-of-life treatments you desire when you have a POLST form.

Note: This page combines and adapts material authored by Peg Sandeen and Arashi Young, published on the previous iteration of our website as blog posts.